Vestibular drop attacks in Ménière’s disease: A systematic review and meta-analysis of frequency, correlates and consequences

Article type: Research Article

Authors: Kutlubaev, Mansur A.^{a; *} | Xu, Ying^{b; c} | Manchaiah, Vinaya^{d; e} | Zou, Jing^{f; g} | Pyykkö, Ilmari^f

Affiliations: [a] Department of Neurology, Bashkir State Medical University, Ufa, Russia | [b] Neuroscience Research Australia (NeuRA), Barker Street, Randwick, NSW, Australia | [c] School of Psychology, University of New South Wales, Sydney, NSW, Australia | [d] Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA | [e] Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India | [f] Hearing and Balance Research Unit, Field of Otolaryngology, School of Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland | [g] Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head & Neck Surgery of the Chinese PLA, Changhai Hospital, Second Military Medical University, Shanghai, China

Correspondence: [*] Corresponding author: Mansur A. Kutlubaev, Department of Neurology, Bashkir State Medical University, Lenin str, 3, Ufa, 450008, Russia. Tel.: +7 347 272 41 73; Fax: +7 (347) 251-10-07, E-mail: Mansur.Kutlubaev@yahoo.com.

Abstract: BACKGROUND:Vestibular drop attacks (VDA), also called Tumarkin otolith crises as a complication of Ménière’s disease (MD) were first described in 1936. Nevertheless, a clearer understanding of their prevalence and manifestations is needed. THE OBJECTIVE:of this review is to determine the frequency, correlates and consequences of VDA in MD. METHOD:Three databases were searched (i.e., MEDLINE, PubMed and Google Academia). A total of 1,791 references were identified, of which 18 studies were considered eligible. There was a large variation in the definition of VDA used in the studies. RESULTS:The frequency of VDA in MD leading to a fall to the ground varied from 3 to 19% in 9 hospital-based studies. In studies where a less restrictive definition of VDA included attacks with postural perturbation, tripping and near-to-fall situations was used the prevalence ranged from 50 to 72%. The pooled frequency of VDA leading to fall to the ground was 8% (95% CI 4 to 12%) in hospital-based studies. In these studies, VDA often occurred in severe and advanced MD whereas in cohort studies such connection was not found. Co-morbidity with migraine increased the likelihood of VDA occurrence in MD. In 3 studies syncope was recorded in connection to VDA with falls. In terms of clinical manifestation, audiometry, MRI, vestibular evoked muscle response measures indicated endolymphatic hydrops with involvement of the otolith system. The hearing loss was more pronounced, and balance was worse in MD patients with VDA than in those without. Injury associated with VDA was reported in only one study. CONCLUSIONS:VDA is a common phenomenon in MD, occurring even in mild MD and complicated with syncope. Some preliminary evidence suggests that VDA may lead to severe injuries.

Keywords: Ménière’s disease, vestibular drop attack, tumarkin otolith crises, vestibular syncope, syncope

DOI: 10.3233/VES-201514

Journal: Journal of Vestibular Research, vol. 32, no. 2, pp. 171-182, 2022